Merck, Gardasil and Coercion (2007 Mar)


by Barry A. Liebling

Cynics have remarked that around every silver lining there is a cloud. A manufacturer can develop a product that has great potential value and then taint it with unwise policies. In February 2007 Merck, the maker of Gardasil, demonstrated how to spoil a good thing.
The silver lining is the new vaccine Gardasil which has recently been approved for preventing cervical cancer. It has been established that women who have been infected with human papilloma virus (HPV) are at risk for cervical cancer. Ordinarily HPV is transmitted via sexual contact. Gardasil can be used to innoculate girls and women against two types of HPV that are known to be carcinogenic agents.

To the extent that Gardasil is proved to be effective and safe in the long-term, it will emerge as an important tool in the armamentarium for preventing cancer. Of course, at this point Gardasil has only been on the market for a short time, so conclusive evidence on its long-term risks is not available.

Women who are contemplating the use of Gardasil, and parents who are considering having young girls inoculated, will have to use their best judgement in weighing the assets and liabilities of being one of the early adopters.

The cloud in the story is the way some government officials and Merck executives have been promoting Gardasil.

In February 2007 the Governor of Texas Rick Perry signed a law that will make it mandatory for girls entering the sixth grade to be vaccinated with Gardasil. While Texas is the first state to enact a Gardasil law, the legislatures of several other states are considering similar measures.

As would be anticipated, the Texas Gardasil law has not been universally praised. It has infuriated a number of groups – including health care professionals and concerned parents – who are intent on thwarting it and preventing similar laws from being enacted in other states.

A number of primary care physicians and pediatricians have criticized the law because they regard Gardasil as too new and as having too many unknown properties. The side effect profile of the vaccine can only be established by watching what happens to early adopters – a research endeavor that will take several years to complete.

Irritated parents have objected to the Texas law on the grounds that it is their right – not the state’s – to make this type of decision for their children. They maintain that they should have the authority to decide if their young daughters will undergo the Gardasil treatment. While it might be argued that a mandatory vaccine is appropriate for diseases that are highly contagious – such as measles, mumps, and chicken pox – HPV is not easily communicable.

Where does Merck fit in to this attempt at legislated force-feeding? Merck has funded a lobbying effort in Texas and in other states to persuade legislators to make Gardasil mandatory for young girls. Rather than campaigning directly, Merck has used Women In Government – an organization of state legislators.

In late February, after the scathing criticisms of the Texas law circulated nationwide, Merck officially announced that it was going to abandon its lobbying efforts to make Gardasil mandatory. The rationale to cease the campaign was that Merck’s “role in supporting school requirements is a distraction from…(cervical cancer prevention).”

Almost on cue, elements of the anti-business crowd clucked that the aborted Merck lobbying effort is just another example of policies being fueled by “corporate greed.” It is easy to see that Merck stands to gain revenues and profits as Gardasil sales grow. And the profits might be enormous if states require girls to be treated with it.

But Merck’s ambition to make money is not the fundamental problem. Merck, like all business enterprises, has a right to unlimited profits providing it conducts itself ethically. An essential condition for ethical business is to deal only by mutual consent. This means that all parties involved must act of their own free will, without coercion. By advocating mandatory treatments, Merck participated in an attempt to violate individual rights.

It is not too late for Merck to act responsibly. In promoting Gardasil it should explain the benefits of using the vaccine, enumerate the potential downsides, and admit that at this time more needs to be learned about its effects.

Merck should talk to government officials, but the message must change. Merck could explain that Gardasil is a valuable treatment to be used only with the voluntary consent of responsible adults – either women or the parents of young girls. Merck should actively lobby against legislation that would coerce individuals to use its products.

If the management of Merck were to think and act right in promoting Gardasil they might recapture the silver lining in their cloud.

*** See other entries at in “Monthly Columns.” ***

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